Sivuleikkaus

Sivuleikkaus, or lateral incision, is a surgical approach in which an incision is made on the side of the trunk to access structures located laterally or in the retroperitoneal space. The exact position depends on the target organ and may follow the flank, subcostal region, or a thoracoabdominal path. The approach can be performed with the peritoneum opened (retroperitoneal or transperitoneal access) or kept retroperitoneal to minimize contamination of the abdominal cavity.

Typical technique involves planning the incision along natural skin and muscle planes. The skin and subcutaneous tissues are divided, and the abdominal wall muscles (often including the external oblique, internal oblique, and transversus abdominis) are encountered and dissected or split to expose the underlying fascia. After the desired structure is exposed, the surgeon may mobilize and protect nearby vessels and nerves before accessing the target organ. Closure usually follows layered suturing of fascia, muscle, subcutaneous tissue, and skin, with attention to reducing tension and preventing postoperative hernia.

Indications for sivuleikkaus include access to lateral or retroperitoneal organs such as the kidneys, adrenal glands, spleen, and parts of the pancreas or liver, or exposure of the lumbar or thoracoabdominal region. It is sometimes favored when a midline incision would provide less direct exposure or when faster entry to the lateral compartment is needed.

Advantages of the approach include direct exposure of lateral structures and potential sparing of midline structures, while disadvantages encompass risk of nerve injury to lateral abdominal wall nerves, greater postoperative pain at the side, and potential hernia formation at the incision site.

In veterinary and human surgery, Sivuleikkaus is one of several regional approaches and is chosen based on anatomy, pathology, and surgeon preference. See also incisions and surgical approaches.